Overview

A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. This opening is formed from the end of the large intestine drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the stoma, and collect in a pouch attached to the patient's abdomen which is changed when necessary.

Types of colostomy

According to anatomic location

According to function

According to appearance

According to duration

According to anatomic location

End sigmoid colostomy - Left iliac fossa

End descending colon colostomy - Left iliac fossa

Transverse colostomy - Above and right to umbilicus

Caecostomy - Right iliac fossa

The appropriate stoma site must be selected pre-operatively for all the elective procedures and for most emergent operations.

According to function that the colostomy is intended for

Diverting colostomy : Any colostomy may be regarded as 'Diverting' if it is so constructed that faeces are prevented from entering the diseased bowel distal to it. They are of 2 types : temporary and permanent

Temporary diverting colostomy : Usually loop colostomy - the purpose is to provide temporary diversion of faeces for :

Protection of the compllicated and threatened distal anastomosis e.g, following anterior resection of rectal cancer

Grossly infected diverticulitis with or without perforation

Traumatic injuries of the colon or rectum

Multiple,complicated and high perianal fistulae

Temporary diverting end colostomy : hartmann's procedure

Permanent diverting colostomy : An end colostomy - the purpose is to provide permanent diversion of faeces for :

Note : In the upper 1/3rd rectal cancer, anterior resection can be performed in selected cases by experienced surgeons.

Indications

There are many reasons for this procedure: a section of the colon has had to be removed, e.g. due to colon cancer requiring a total mesorectal excision, diverticulitis, injury, etc, so that it is no longer possible for feces to pass out via the anus; or a portion of the colon (or ileum) has been operated upon and needs to be 'rested' until it is healed. In the latter case, the colostomy is often temporary and is usually reversed at a later date, leaving the patient with a small scar where the stoma was.

Options

Colostomies are viewed negatively due to the misconception that it is difficult to hide the pouch and the smell of feces, or to keep the pouch securely attached. However, modern colostomy pouches are well-designed, odor-proof, and allow stoma patients to continue normal activities. Latex-free tape is available for ensuring a secure attachment.

Colostomates (people with colostomies) who have ostomies of the sigmoid colon or descending colon may have the option of irrigation, which allows for the person to not wear a pouch, but rather just a gauze cap over the stoma. By irrigating, a catheter is placed inside the stoma, and flushed with water, which allows the feces to come out of the body into an irrigation sleeve. Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their health.

Placement of the stoma on the abdomen can occur at any location along the colon, the majority being on the lower left side near or in the sigmoid colon, other locations include; the ascending, transverse, and descending sections of the colon. Colostomy surgery that can be planned ahead often has a higher rate of long-term success and satisfaction than those done in emergency surgery.

Living with a colostomy

People with colostomies must wear an ostomy pouching system to collect intestinal waste. Ordinarily the pouch must be emptied or changed several times a day depending on the frequency of activity; in general the further from the anus the ostomy is located the greater the output and more frequent the need to empty or change the pouch.

Alternatives

In some rare situations it may be possible to opt for an internal colo-anal pouch which eliminates the need for an external pouch. In place of an external appliance, an internal ileo-anal pouch is constructed using a portion of the patient's lower intestine, to act as a new rectum to replace the removed original.